The Correlation Between hs CRP TG Triglycerides Glucose Index in NAFLD and Liver Fibrosis

Official title

Correlation Between hs CRP TG Triglycerides Glucose Index in NAFLD and Liver Fibrosis

Overview

The Correlation between hs CRP TG triglycerides Glucose index in NAFLD and liver fibrosis

Detailed description

Non-Alcoholic Fatty Liver Disease (NAFLD) is the most prevalent chronic liver disease in the world, affecting one-fourth of the global population, and represents a serious public health issue. NAFLD encompasses a broad spectrum of liver abnormalities, ranging from simple hepatic steatosis, which is thought to be benign, to non-Alcoholic Steatohepatitis (NASH) without fibrosis and progressing to fibrotic NASH. The evolution of liver fibrosis results in irreversible architectural changes of the liver and can progress to Hepatocellular Carcinoma (HCC) (Sheka et al., 2020; Zhou et al., 2025). NAFLD is associated with an increased risk of systemic metabolic disorders, such as hyperuricemia, hyperlipidemia, IR, and hyperglycemia. These metabolic disorders, in combination with NAFLD, contribute to the risk of developing extrahepatic malignancies and cardiovascular diseases, which are the main causes of extrahepatic mortality (Li et al., 2022).

High-sensitivity C-reactive protein (hs-CRP) is a widely used biomarker for measuring systemic inflammation and is readily available for measurement. It is especially useful for identifying low-grade inflammation and has been associated with adverse health outcomes, including cardiovascular disease, metabolic syndrome, insulin resistance, and decreased physical function (Banait et al., 2022; Son et al., 2022). In addition, hs-CRP is a marker of pro-inflammatory cytokines such as interleukin-6 (IL- 6) and tumor necrosis factor-alpha (TNF-α), and it has been used as a useful and valid marker of inflammation in large-scale epidemiological studies (Banait et al., 2022). In addition, the C-reactive protein-triglyceride glucose index (CTI) is a composite index that integrates the triglyceride and glucose (TyG) index with hs-CRP, thus reflecting both insulin resistance and systemic inflammation. Previous studies have found that the CTI is linked to various diseases, such as coronary heart disease, depression, stroke, NAFLD, and liver fibrosis (Ruan et al., 2022 Recent research has helped elucidate the pathogenic roles of insulin resistance (IR) and inflammation in NAFLD. Patients with non-alcoholic steatohepatitis (NASH) are likely to have higher levels of high-sensitivity C-reactive protein (hs-CRP) and pro-inflammatory cytokines, which could contribute to chronic inflammation and disease progression. Moreover, systemic inflammation is known to play a pivotal role in the pathogenesis of advanced cirrhosis (Ling et al., 2023). The triglyceride-glucose (TyG) index, a non-invasive surrogate marker of insulin resistance, is strongly linked with the development and progression of hepatic steatosis and fibrosis. The combined high-sensitivity C-reactive protein and triglyceride glucose index (CTI), which combines TyG and hs-CRP, offers a comprehensive estimate that reflects both insulin resistance and inflammation (Ruan et al., 2022; Xu et al., 2024). However, there are only a limited number of studies with a limited number of patients that have addressed the Correlation between the hs-CRP-triglyceride glucose index and NAFLD and liver fibrosis.

Interventions

• Other • Fasting triglycerides (TG) • Fasting plasma glucose • High-sensitivity C-reactive protein (hs-CRP) • Liver enzymes (ALT, AST, GGT) • Platelet count • HbA1c • Lipid profile (total cholesterol, HDL-C,
  Participants will be instructed to fast for 8-12 hours before blood sampling. Venous blood samples will be collected in the morning and analyzed in a certified laboratory for: * Fasting triglycerides (TG) * Fasting plasma glucose * High-sensitivity C-reactive protein (hs-CRP) * Liver enzymes (ALT, AST, GGT) * Platelet count * HbA1c * Lipid profile (total cholesterol, HDL-C, LDL-C)

Primary outcome measures

• Presence of NAFLD (defined by CAP ≥248 dB/m after exclusion of secondary causes). [Time frame: 1Year]

Eligibility criteria

Inclusion criteria

• Adults ≥18 years
• Available fasting labs: TG, fasting glucose, hs-CRP
• Valid liver assessment by VCTE (FibroScan LSM) and CAP or ultrasound-based steatosis assessment

Exclusion criteria

• 1- Significant alcohol intake (define using your local standard; commonly sex-specific thresholds) 2- Viral hepatitis (HBsAg positive and/or HCV RNA positive) 3- Other chronic liver diseases (autoimmune hepatitis, hemochromatosis, Wilson's, etc.) 4- Pregnancy

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Observational model

Other

Study locations

Egypt · 1 center

• Assiut University Hospital Assiut, Assiut Governorate — Asyut

Publications

• Zhou Y, Lin H, Weng X, Dai H, Xu J. Correlation between hs-CRP-triglyceride glucose index and NAFLD and liver fibrosis. BMC Gastroenterol. 2025 Apr 12;25(1):252. doi: 10.1186/s12876-025-03870-7. PMID 40221654
• Xu M, Zhang L, Xu D, Shi W, Zhang W. Usefulness of C-reactive protein-triglyceride glucose index in detecting prevalent coronary heart disease: findings from the National Health and Nutrition Examination Survey 1999-2018. Front Cardiovasc Med. 2024 Oct 15;11:1485538. doi: 10.3389/fcvm.2024.1485538. eCollection 2024. PMID 39473894
• Son DH, Song SA, Lee YJ. Association Between C-Reactive Protein and Relative Handgrip Strength in Postmenopausal Korean Women Aged 45-80 Years: A Cross-Sectional Study. Clin Interv Aging. 2022 Jun 17;17:971-978. doi: 10.2147/CIA.S356947. eCollection 2022. PMID 35747693
• Sheka AC, Adeyi O, Thompson J, Hameed B, Crawford PA, Ikramuddin S. Nonalcoholic Steatohepatitis: A Review. JAMA. 2020 Mar 24;323(12):1175-1183. doi: 10.1001/jama.2020.2298. PMID 32207804
• Ruan GT, Xie HL, Zhang HY, Liu CA, Ge YZ, Zhang Q, Wang ZW, Zhang X, Tang M, Song MM, Zhang XW, Yang M, Chen YB, Yu KY, Deng L, Gong YZ, Hu W, Wang KH, Cong MH, Shi HP. A Novel Inflammation and Insulin Resistance Related Indicator to Predict the Survival of Patients With Cancer. Front Endocrinol (Lausanne). 2022 Jun 20;13:905266. doi: 10.3389/fendo.2022.905266. eCollection 2022. PMID 35795140
• Ling Q, Chen J, Liu X, Xu Y, Ma J, Yu P, Zheng K, Liu F, Luo J. The triglyceride and glucose index and risk of nonalcoholic fatty liver disease: A dose-response meta-analysis. Front Endocrinol (Lausanne). 2023 Jan 19;13:1043169. doi: 10.3389/fendo.2022.1043169. eCollection 2022. PMID 36743937
• Li Q, Han Y, Hu H, Zhuge Y. Gamma-glutamyl transferase to high-density lipoprotein cholesterol ratio has a non-linear association with non-alcoholic fatty liver disease: A secondary prospective cohort study in non-obese Chinese adults. Front Med (Lausanne). 2022 Nov 17;9:995749. doi: 10.3389/fmed.2022.995749. eCollection 2022. PMID 36465946
• Banait T, Wanjari A, Danade V, Banait S, Jain J. Role of High-Sensitivity C-reactive Protein (Hs-CRP) in Non-communicable Diseases: A Review. Cureus. 2022 Oct 12;14(10):e30225. doi: 10.7759/cureus.30225. eCollection 2022 Oct. PMID 36381804

Identifiers

NCT: NCT07513922 · hs CRP TG Glucose index

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗